Type 2 Diabetes: Yesterday, Today & Tomorrow
- Diabetes, Type 2
YESTERDAY
- No proven strategies existed to prevent the disease or its complications.
- The only ways to treat diabetes were the now-obsolete forms of insulin from cows and pigs, and drugs that stimulate insulin release from the beta cells of the pancreas (sulfonylureas). Both of these therapies cause dangerous low blood sugar reactions and weight gain. Patients monitored their glucose levels with urine tests, which recognized high but not dangerously low glucose levels and reflected past, not current, glucose levels. More reliable methods for testing glucose levels in the blood had not been developed yet.
- While scientists knew that genes played a role (i.e., the disease often runs in families), they had not identified any specific culprit genes.
- National efforts were not being made to combat obesity—a serious risk factor for the disease. Fewer people developed type 2 diabetes compared to today because overweight, obesity, and physical inactivity were not pervasive.
- Patients were almost exclusively adults—the reason that the disease was formerly called “adult onset diabetes.” It was rare in children or young adults.
TODAY
- Type 2 diabetes can be prevented or delayed. The NIH-funded Diabetes Prevention Program (DPP) clinical trial (http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/) found a lifestyle intervention (modest weight loss of 5 to 7 percent of body weight and 30 minutes of exercise 5 times weekly) reduced the risk of getting type 2 diabetes by 58 percent in a diverse population of over 3000 adults at high risk for diabetes. In another arm of the study, the drug metformin reduced development of diabetes by 31 percent.
- Based on the DPP findings, the National Diabetes Education Program developed the education campaign, “Small Steps. Big Rewards. Prevent Type 2 Diabetes.” to help people at high risk take the necessary steps to prevent the disease (www.ndep.nih.gov).
- Ongoing NIH translational research efforts are testing cost effective ways to deliver the DPP-proven lifestyle change in real-world settings. This vigorous effort is needed to address the escalating prevalence of type 2 diabetes which now affects 7.8 percent of Americans, disproportionate affects minorities, and is conservatively estimated to be the seventh leading cause of death in the U.S.
- Type 2 diabetes is increasing in children, in tandem with rising obesity rates. This trend is alarming because, as younger people develop the disease, the complications, morbidity, and mortality associated with diabetes are all likely to occur earlier. Also, offspring of women with type 2 diabetes are more likely to develop the disease. Thus, the burgeoning of diabetes in younger populations could lead to a vicious cycle of ever-growing rates of diabetes.
- The SEARCH for Diabetes in Youth Study (www.searchfordiabetes.org) has provided the first national data on incidence and prevalence of diabetes in youth. About 3700 youth under 20 years old are diagnosed with type 2 diabetes each year, and the disease is particularly prevalent in minority youth.
- Research has vastly expanded understanding of the molecular underpinnings of diabetes and its complications. Recent work has boosted to nearly 40 the number of gene regions associated with increased risk of type 2 diabetes, laying the foundation for new approaches to prevention and therapy.
- NIH-supported clinical trials validated a marker called hemoglobin A1C (A1C). This marker reflects average blood sugar control over a 3 month period. This technology, along with tests that allow patients to monitor their own blood glucose throughout the day, helps make better blood glucose control achievable for many people with type 2 diabetes.
- Because lower A1C levels have been shown to be predictive of longer life and fewer complications, the test has helped speed development and approval of better forms of insulin and new diabetes medicines that work though a variety of mechanisms. New drugs are available that lower glucose without weight gain or even with modest weight loss. Several agents targeting the specific metabolic abnormalities of type 2 diabetes are now available and can be combined, thus delaying the need for insulin.
- Tight blood sugar control has become a standard of treatment for most diabetes patients based on results from NIH clinical trials demonstrating that keeping A1C below 7 can prevent or delay devastating disease complications.
- A large clinical trial showed that older patients with longstanding type 2 diabetes at high risk of heart disease do not benefit from more intensive blood glucose control than is currently recommended. These findings spare patients from unneeded therapy and provide important data to help individualize therapy, with less stringent A1C targets suggested for some people such as those with advanced diabetes complications.
- Clinical trials have shown that blood pressure and lipid control reduce diabetes complications by up to 50 percent. Physicians are now much better equipped to prevent and control heart disease, which often accompanies diabetes, and is the leading cause of death in people with diabetes.
- Nationwide improvements in risk factor control show research-proven strategies are being translated into practice. Improvements in control of cholesterol, blood glucose, and blood pressure have added an estimated one year to the expected lifespan of a person with type 2 diabetes since 1992, and improved quality of life by reducing the incidence of burdensome complications like blindness, lower limb amputations, kidney failure, and coronary heart disease.
- As a result of research proving their benefits, Medicare now covers blood glucose self monitoring materials and diabetes education services, helping people to better control their diabetes.
- Kidney disease can be detected earlier via urine tests. Therefore, patients can be treated earlier to slow the rate of kidney damage. Improved control of glucose and blood pressure prevents or delays progression of kidney disease to kidney failure. With good care, less than 10 percent of patients develop kidney failure.
- With timely laser surgery and appropriate follow-up care, people with advanced diabetic retinopathy can reduce their risk of blindness by 90 percent. A recent study showed a drug which limits blood vessel growth can be an important supplement to laser therapy for diabetic macular edema.
- The NIH spent over $1.1 billion on diabetes research in fiscal year 2009. In 2007, total costs attributable to diabetes for Americans was estimated at $174 billion—an increase of 32 percent since 2002.
TOMORROW
- Research will find better ways to bring proven diabetes prevention strategies to more people at lower cost.
- Earlier and more aggressive treatment approaches may help better prevent diabetes complications.
- New understanding of the biology of obesity and insulin resistance is informing the development of new therapeutics to prevent and treat type 2 diabetes.
- Identification of susceptibility genes for diabetes and its complications will enable earlier implementation of prevention measures targeted to those at highest risk.
- Research on the effect of maternal diabetes on offspring may help to break the vicious diabetes cycle.
- Continued research on the mechanisms underlying the development and progression of disease complications will result in the ability to predict who is likely to develop them. Personalized treatments could then be developed to preempt complications. This strategy would dramatically improve the health and well-being of patients.
- NIH clinical trials will identify new approaches to prevent and treat the emerging problem of type 2 diabetes in children.
For more information, contact The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): NIDDKinquiries@nih.gov
The National Institute of Diabetes and Digestive and Kidney Diseases www.niddk.nih.gov
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
The Best Core Pilates Workout Video
Source: Uploaded by diethealth on Aug 14, 2008 to YouTube
A free online exercise and fitness Pilates total abs and core workout video you can do in five minutes.
Obesity is Getting Bigger in the United States
July 7th, 2011
Obesity is getting bigger in the United States
Two-thirds of all adults and about a third of all children and teenagers in the United States are overweight or obese according to a report release Thursday by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).
According to “F as in Fat: How Obesity Threatens America’s Future 2011,” adult obesity increased in 16 states during the past year and rates soared to 30% or more in these 12 states: Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia. Four years ago, only one state – Mississippi – had an adult obesity rate of more than 30%. No state showed a decrease in it obesity rate in Thursday’s report.
Nine of the 10 states with the highest adult obesity numbers are in the South. Mississippi, for the seventh year in a row, had the highest adult obesity rate at 34.4%. Colorado, at 19.8%, had the lowest, and in fact is the only state in the country with an adult obesity rate under 20%. Twenty years ago no rate was above 15%. The report found rates grew fastest in Alabama, Tennessee and Oklahoma and slowest in Colorado, Connecticut and the District of Columbia.
“There was a clear tipping point in our national weight gain over the last twenty years,” said Jeff Levi, Executive director of TFAH. “And we can’t afford to ignore the impact obesity has on our health and corresponding health care spending.”
According to the Centers for Disease Control and Prevention, the medical costs associated with obesity are staggering– totaling about $147 billion in 2008. More than 80% of people in this country with type-2 diabetes are overweight and new diagnoses doubled in 10 years, according to Thursday’s report. Overweight and obese people are at risk of developing high blood pressure and high cholesterol, risk factors for cardiovascular disease and stroke. They may also be at greater risk of colon, kidney and esophageal cancer.
African Americans, Latinos, those with low incomes and less education had the highest overall rates, topping 30 to 40% in many states. The report found about 33% of adults who made less than $15,000 a year or did not graduate from high school were obese.
The researchers found that a lack of access to fresh fruits, vegetables and other healthful foods in some neighborhoods and a dearth of safe community areas for families to walk and for children to play all factor into the obesity epidemic.
But there’s more to it. “Portion sizes in restaurants are much larger than they have been, soft drinks at convenience stores are much larger than they have been,” said Dr. James Marks, senior vice president of the Robert Wood Johnson Foundation. “When people have a larger size they will eat more. Snacking has gone up more and more. All of these things contribute.”
“We’ve built inactivity into our lifestyles. We’ve designed communities around cars,” said Levi. “Kids are watching TV and sitting around computers. We’ve found plenty of ways to entertain ourselves that don’t include activity.”
“The information in this report should spur us all – individuals and policymakers alike – to redouble our efforts to reverse this debilitating and costly epidemic,” said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. “Changing policies is an important way to provide children and families with vital resources and opportunities to make healthier choices easier in their day-to day-lives.”
Recommendations include making sure all food and drinks sold in schools meet the most recent Dietary Guidelines for Americans, increasing access to quality and affordable foods, expanding the amount and intensity of physical activity in schools and in out-of-school programs, increasing physical activity by providing communities safe places to walk, bike and play, introducing pricing incentives to help people buy healthier foods and regulating how and where unhealthy foods are marketed to children.
Marks says what’s particularly tragic is the increase in type 2 diabetes among younger adults and kids. “Since the 1970s, the rate of obesity has tripled or quadrupled in children,” said Marks. “We’ve got an even larger problem coming in our children.”
Source: Saundra Young – CNN Medical Senior Producer
Michael Pollen’s : “Don’t Buy Any Food You’ve Ever Seen Advertised”. Parts 1 and 2 on Democracy Now 5/14/09
Part 1
Part 2
Source: Uploaded by mediagrrl9 on May 14, 2009 on YouTube
Michael Pollan is one of the nations leading writers and thinkers in this country on the issue of food. He is author of several books about food, including The Botany of Desire, The Omnivores Dilemma and his latest, In Defense of Food: An Eaters Manifesto. In light of what he calls the processed food industry’s co-option of sustainability and its vast spending on marketing, Pollan advises to be wary of any food that’s advertised.
Diabetes: The Worldwide Epidemic
by Ty Bolton (submitted 2011-06-04)
Diabetes has become an ever increasing problem, and is a worldwide epidemic. There’s an estimated 285 million people living with diabetes. That number is expected to grow to almost 430 million by the year 2030, and affect 7% of the World’s adult population.
The majority of those being diagnosed with diabetes live in low income countries. India currently has the largest population of those diagnosed with diabetes. Estimates say there are 40 million people living with diabetes in India alone, followed by China. Africa is expected to have the largest increase of diabetes in the years to come.
Diabetes can affect a person at any age, but people between the ages of 40-59 have the highest risk of being diagnosed with the disease. There’s been an increase of diabetes in all nations, for the last 50 years.
In spite of warnings from health organizations, the epidemic continues to grow throughout the world. Leaders from around the world still continue to ignore the threat. Complications from diabetes are one of the leading causes of premature death.
There are many people that live with Type 2 Diabetes for years before being diagnosed. Living with diabetes for an extended period of time without any treatment will cause many adverse health problems.
If diabetes is left untreated, the complications can range from kidney failure to death. Type 2 Diabetes can be prevented in 80-85% of people, if they change their lifestyle. Managing Type 2 Diabetes is as simple as changing your diet and exercising.
A good quality of life, can often times reverse Type 2 Diabetes. Type 2 Diabetes is diagnosed among minorities and lower income people more than any other group. Environmental factors, and poor living conditions also play a part in developing Type 2 Diabetes.
These groups normally don’t’ have the income or access to healthy foods that can help prevent them from getting the disease. Instead, they have to consume unhealthy processed foods and drinks.
Substance abuse can also play a role in contributing to diabetes. If you’re a diabetic, you should never smoke or drink alcohol. Getting plenty of rest and reducing your stress levels will help reduce your chances of developing further diabetes complications.
Know and understand the early warning signs and symptoms of diabetes. If you’re at risk for premature diabetes, change your lifestyle and see your doctor. A simple treatment plan and lifestyle change will possibly save you from being diagnosed with diabetes.
Diabetes is a deadly disease, and accounts for thousands of deaths each year from complications. Each year, diabetes kills the same amount of people as those who die from HIV/AIDS complications each year.
About the Author
We all should learn more about the causes of diabetes and how food, cigarettes and other factors contribute to diabetes. http://1n2.co
Ty Bolton
Source: GoArticles.com © 2011, All Rights Reserved.
Patti Labelle: Living with Diabetes
Source: Uploaded by mediaADA on Jun 28, 2007 to YouTube
Patti Labelle explains how working with a registered dietitian can help you live a healthy life if you have diabetes.
Diabetics get Blood Vessels Made From Donor Cells
By MARILYNN MARCHIONE, AP Medical Writer
2:28 p.m., June 27, 2011
Three dialysis patients have received the world’s first blood vessels grown in a lab from donated skin cells. It’s a key step toward creating a supply of ready-to-use arteries and veins that could be used to treat diabetics, soldiers with damaged limbs, people having heart bypass surgery and others.
The goal is to one day have a refrigerated inventory of these in various sizes and shapes that surgeons could order up as needed like bandages and other medical supplies.
The work so far is still early-stage. Three patients in Poland have received the new vessels, which are working well two to eight months later. But doctors are excited because this builds on earlier success in about a dozen patients given blood vessels grown in the lab from their own skin – a process too long and expensive to be practical.
“This version, built from a master donor, is available off the shelf and at a dramatically reduced cost,” estimated at $6,000 to $10,000, said Todd McAllister, chief of Cytograft Tissue Engineering Inc., the San Francisco-area company leading the work.
The American Heart Association considers it so promising that the group featured it on Monday in the first of a new series of webcasts about cutting-edge science.
“This is tremendously exciting,” because the failure of blood vessels used in dialysis is “a huge public health problem,” said Duke University‘s Dr. Robert Harrington, a heart expert who had no role in the work.
If a larger study getting under way now in Europe and South America shows success, “this is big news,” Harrington said.
Kidney failure, which is common in diabetics, requires dialysis to filter wastes from the blood through a connection between an artery and a vein called a shunt. It gets punctured several times a week to hook patients up to the dialysis machine, and complications include blood clots, clogging and infection.
What’s more, patients often run out of suitable sites for these shunts as problems develop. Plastic versions have high rates of failure and complications, too. Doctors have long wished for a natural substitute.
The lab-grown vessels are free of artificial materials. They don’t involve stem cells, so they’re not controversial.
Researchers start with a snip of skin from the back of a hand, remove cells and grow them into sheets of tissue that are rolled up like straws to form blood vessels.
So far, these lab-grown vessels have been tolerated by the recipients’ immune systems; no anti-rejection medicine or tissue matching is needed. That’s not surprising because lab-grown skin is already used to treat many burn victims.
“There are literally hundreds of thousands of patients that could use this technology,” McAllister said.
Each year, nearly 400,000 Americans undergo dialysis and half of them use plastic shunts. More than 160,000 people lose limbs because of poor circulation that might be improved with lab-grown vessels.
About 300,000 people have heart bypass operations using blood vessels taken from other parts of the body to create detours around clogged heart arteries. Some heart patients say the leg wound from removing the long vein to create heart bypasses hurts more than the chest wound for the open-heart surgery.
In 2005, Cytograft reported success with its first attempt at dialysis shunts using patients’ own skin. Some of the early work was sponsored by the National Heart, Lung and Blood Institute.
The new work, using donor cells, makes this advance more practical for wide use, said Dr. Timothy Gardner, a heart surgeon at Christiana Care Health Services in Newark, Del., and former American Heart Association president.
“It provides the option or the opportunity for off-the-shelf graft availability as opposed to something that has to be built from the individual’s own cells,” he said.
Cytograft plans a study in Europe and South America comparing 40 patients getting the lab-grown vessels to 20 getting plastic shunts. Studies also are planned on a mesh version for people with poor leg circulation.
Online:
Company and video: http://www.cytograft.com
Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP
Source: The Associated Press/San Diego Union-Tribune
Diabetic Foot Care – Podiatrist in Jacksonville, FL
Source: Uploaded by webpowervideo on Dec 3, 2009 to YouTube
According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.
Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.
With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.
Here’s some basic advice for taking care of your feet:
Always keep your feet warm.Don’t get your feet wet in snow or rain.
Don’t put your feet on radiators or in front of the fireplace.
Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.
Don’t soak your feet.
Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
Use quality lotion to keep the skin of your feet soft and moist, but don’t put any lotion between your toes.
Wash your feet every day with mild soap and warm water.
Wear loose socks to bed.
Wear warm socks and shoes in winter.
When drying your feet, pat each foot with a towel and be careful between your toes.
Buy shoes that are comfortable without a “breaking in” period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don’t wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don’t lace your shoes too tightly or loosely.
Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.
When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced “sharko”) foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn’t hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.
The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot’s movement and supports its contours if you don’t put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.
Visit our website: http://www.firstcoastfootclinic.com
Are You Addicted To Food?
By Rachael Moeller Gorman, “Addicted to Food?,”March/April 2011 in Eating Well
Food can enslave the brain just like drugs can. Dr. Nora Volkow’s research may help you take back control.
Every morning, Nora Volkow walks past a vending machine on her way to her office. She barely notices it. One day, however, she’s hungry, so she stops and peers in. A chocolate bar grabs her eye. She inserts her money, takes the chocolate, munches, and moves on. The next day, Volkow walks to her office as usual, but this time as she rounds the corner, she has a sudden, intense craving for chocolate. She hadn’t thought about it since her last bite the day before. She isn’t hungry. “But my brain responded in this automatic way,” she explains in her melodic Spanish accent as she sits in her office at the National Institute on Drug Abuse (NIDA), where she serves as director. Because the chocolate had given her so much enjoyment, just the sight of the machine made her want to eat more.
Volkow, a lithe woman with short blonde curls, provides example after example of instances in which she has succumbed to the food’s lure. Chocolate-covered raisins. Godiva at a bookstore. Chocolate-chip cookies. The woman really, really likes chocolate.
But is she an addict? People talk about being “addicted to sugar,” “addicted to potato chips” and, probably most commonly, “addicted to chocolate.” Volkow has been attempting to figure out whether we truly can be addicted to food by peering into people’s minds with high-tech scanners. She has already shown that obese people’s brains look similar to the brains of those addicted to drugs. She’s finding that food, especially the highly palatable fatty, sugary kinds that pack the inner aisles of American supermarkets, fast-food joints and, yes, vending machines, can enslave anyone and change their behaviors.
The more she can understand how “rewarding” substances, like drugs and yummy foods, can activate parts of our brains associated with addiction, the more she can help us learn how to take back control of our actions—or never lose our free will in the first place.
The Makings of a Pioneer
If you were to imagine a person whose pedigree and character destines her for a key leadership role, an NIH director, say, you might picture someone quite like Nora Volkow. Volkow’s great-grandfather was Leon Trotsky, the famous Russian revolutionary who defied Stalin, only to later be murdered in exile in Volkow’s childhood home in Mexico City. Her mother, a Spanish fashion designer, died several years ago, and her father is a chemist who still lives in Mexico. Nora Volkow herself graduated first in her class at the National University of Mexico medical school and received the Premio Robins award for best medical student of her generation. She speaks four languages fluently. She runs seven miles before work every day. She works an average of 80 hours every week.
Yet for the sake of science, she perpetually brings up her own weaknesses. Like chocolate. Which we keep coming back to.
“The other day someone gave me chocolate-covered raisins,” she says, swinging her ID chain with both hands, a twinkle in her eye. “They gave me two boxes, so I say, OK, I’ll eat half a box. Well, I ate one-and-a-half boxes!” This sort of compulsive eating, she says, is one reason that obesity has become an epidemic. Many people blame obese people for their condition, saying they simply eat too much. But it’s not that obese people lack willpower, says Volkow; there is something physical happening in their brains that prevents them from stopping. “Obesity is highly, horrifically stigmatized,” says Volkow. “It erodes your self-esteem, it interferes with social interactions, it affects your mobility. And yet so often people cannot stop it.”
The Dopamine Made Me Do It
Volkow’s interest in the chemistry and mechanisms of the brain began in Mexico City in 1981. She had just graduated from medical school and read an article in Scientific American about exciting new clinical applications of a technology called positron emission tomography (PET). PET allows scientists to see a three-dimensional image of the brain as it thinks, feels and works (previously, scientists could not watch the brain in action very well). Volkow was awestruck, and applied for a psychiatric residency at New York University to have a chance to work with nearby PET pioneers at the Department of Energy’s Brookhaven National Laboratory on Long Island.
She was particularly interested in the brains of people who lose the ability to control their actions rationally; people who, in essence, lose free will. At first, she studied schizophrenics. By the late 1980s, she started looking at the brains of alcoholics and drug addicts as well. She soon saw that the addicted brains looked decidedly different from brains of people without drug or alcohol addictions.
The most marked difference was in the dopamine cells of the reward circuit, a group of brain cells that communicate using the chemical dopamine. The circuit connects several regions in the brain involved in the feeling of reward, which has evolved to motivate us to do more of the things that make us feel good and are important for survival, like eating, having sex and taking care of children. Drugs like cocaine and amphetamines highjack this circuit, causing a flood of dopamine into the area between brain cells where messages are transmitted. And this dopamine surge produces a high. Take the drugs often enough and dopamine receptors can decrease in number or become less sensitive to dopamine. When this happens, a person needs more and more of the drug to get the same effect (this is called tolerance).
As a psychiatrist, Volkow noted a similarity between drug abusers and compulsive overeaters: they both seemed to lose their rational ability to control their behaviors (around drugs and food, respectively). She wanted to know how to intervene to help those who couldn’t stop themselves. She knew that antipsychotic drugs, which block the reward-registering dopamine system, often make people eat and gain weight (as a side effect), while drugs that increase dopamine in the brain cause weight loss. In 2001, Volkow and her colleagues began exploring whether dopamine played a key role in overeating and obesity in people not on drugs.
To find out, Volkow and her crew gave a radioactive chemical that binds to dopamine receptors to 20 people—10 obese, 10 normal weight—and then scanned their brains using PET, to see whether there were any associations between their dopamine systems and their body weights.
Turns out, there were. The obese people had significantly fewer dopamine receptors in a part of the brain called the striatum. Volkow and her team surmised that with fewer receptors, the people who were obese had to eat far more food than a normal-weight person to experience the same high.
Liking and Wanting
In 2002, Volkow published a study that investigated the link between dopamine and “wanting.” When people were presented with—but not allowed to eat—warm, tasty plates of their favorite food, dopamine increased in the striatum area of their brains. The subjects said they were hungry and desired the food. This is the “wanting,” or craving; it is not the pleasure (i.e., “liking”) they likely would have experienced if they had been allowed to consume it. The people’s responses in this study were quite similar to the experiences of drug abusers watching a video showing people using cocaine: the abusers experience a dopamine surge through the parts of the brain involved in habit.
In other words, really liking chocolate or potato chips, the pleasure that occurs when your reward systems fire, isn’t the whole story of dopamine and addiction. An intense want—the desire to eat, to do everything you can to get your hands on a food and put it into your mouth—is equally important. You taste creamy milk chocolate or a salty French fry. You really, really like it. So much so that you’re conditioned to the setting in which you ate the yummy food and the next time you’re in that environment, a shot of dopamine squirts into your brain and you want that food. You crave it. You’re motivated to eat it—and to keep eating it.
This idea is central to the obesity epidemic. “There is a certain reinforcement, almost like an arousal of wanting more,” says Volkow. “A person eats a gallon of ice cream. He is not even realizing the taste of the food anymore, he’s not enjoying the pleasure of the palatability and experience; it has become automatic. The drive to have more and more [fueled by dopamine] is what maintains that behavior, independent at that point of the pleasurable response that you get.
“It’s almost like they become a robot.”
You’ve Been Conditioned
No one would become a food-devouring robot, however, if they lived in a desert or on the moon or in the year 1850, according to David Kessler, M.D., former FDA commissioner and author of The End of Overeating (Rodale, 2009). We eat, he says, because we have constant, crippling access to rich, delicious foods packed with fat and sugars, both of which activate our dopamine systems. And those conditioned cues are everywhere—commercials, fast-food restaurants that we pass on our commutes, grocery stores. Kessler postulates that fat and sugar, plus salt, have triggered mass overconsumption in the United States.
“We took fat, sugar and salt and put it on every corner, made it available 24/7, made it socially acceptable to eat anytime. We’re living in a food carnival,” he says.
Volkow’s Bethesda offices are a perfect microcosm of this American food environment: Within one-third of a mile, a visitor can find a frozen yogurt place, a greasy-spoon diner, a Mexican restaurant and at least 10 other eateries. On the first floor of the NIDA offices is a cafeteria with a hot buffet and snacks. Vending machines, like the one Volkow has a hard time resisting, live on the office floors themselves. Bowls of candy lurk on desktops and in drawers. The scent of microwave popcorn pervades the office air.
The continual need to say “NO!” to these tempting foods requires the strongest will, and some people’s wiring seems to be working against them. In a 2008 study, Volkow found that having fewer dopamine receptors (as obese people do) was associated with less activity in parts of the brain responsible for self-control. In other words, these people not only have to eat more to achieve the same “reward,” they also have a harder time stopping themselves from eating once they start. Drug addicts similarly have fewer dopamine receptors, also associated with less activity in the self-control parts of the brain. In the brain of a compulsive, “addicted” eater, inhibition is like a picket fence trying to hold back an avalanche of reward and conditioning.
“Joanne,” 39, from San Francisco, a member of Food Addicts in Recovery Anonymous, agrees, and says that sugar and flour are her drugs. Since she was a teenager, Joanne would compulsively eat for hours at a time; in high school she learned how to make herself sick, which “led to 15 years of insanity,” she says. “There was something in my brain that would light up, and it would turn into this massive craving that I could not control.”
Joanne’s food addiction manifested as bulimia, but others in the group became obese. When she wasn’t purging, she was “white-knuckling it” through the day. “If there was food somewhere in the vicinity, the constant conversation in my head was, ‘Should I eat that? No, don’t eat that.’ Back and forth, over and over, while trying to maintain a conversation, which was almost fruitless because I wasn’t really listening, I was focused on the food.” Studies have estimated that about 10 percent of the population is addicted to food like this, and many more of us probably fall elsewhere on the food-addiction spectrum.
“Everyone understands how critical taste is [to overeating], but what Nora has shown is the role not just of taste, but of the brain and brain circuits,” says Kessler. “We now know that the learning, memory, habit and motivational circuits of the brain are what drive eating, and Nora deserves a lot of credit for pulling back the curtain and showing us what’s really at the core of this [obesity] epidemic.”
Breaking the Cycle
But even though we are inundated with hyper-palatable food, not everyone becomes an addict. “At least 50 percent of that vulnerability is related to genetics,” Volkow says. And your ability to put on the brakes is a crucial factor. “Some people are [naturally] much better at controlling their desires than others.” After genetics, Volkow says the rest is environment—if you only have access to high-calorie, cheap junk foods, that’s all you can eat.
Not everyone in the field agrees that people can be addicted to food and they object to the excuse it provides. “Interest in obesity as a brain disease should not detract from a public health focus on the ‘toxic food environment’ that is arguably responsible for the obesity epidemic,” writes psychologist Terry Wilson, Ph.D., of Rutgers University in a 2010 paper. But those who study food addiction say it does bear striking similarity to drug and alcohol addition: Ashley Gearhardt, Kelly Brownell and William Corbin at Yale have created the Yale Food Addiction Scale to determine whether a person is truly addicted to food. They adapted it from the scale for substance dependence in the DSM-IV (the “Bible” of psychiatry), and it includes criteria like whether the subject has been unsuccessful in trying to quit, whether he or she spends a lot of time trying to obtain the food, whether he or she has given up other recreational activities for the food, whether there are adverse consequences of eating the food, whether the subject becomes tolerant to the food and whether they have withdrawal symptoms. When they surveyed 233 people, these three leading researchers found that 11.6 percent of them could be diagnosed with food dependence (consuming large amounts of food despite significant issues—obesity, health problems—associated with it and the desire to stop, as well as withdrawal or tolerance). The scale could be useful in determining treatment for addicts versus those who simply experience the occasional craving.
Back in her office, surrounded by sculptures and paintings, some from her own hand (yes, she’s an artist too!), Volkow talks about how addiction steals our free will and makes us a slave to the salient substance. So is Nora Volkow a chocolate addict? “No, I’m not. We use the word way too much.” The distinction, she says, is when eating the food impairs your life, when you lose control, like when a person consistently eats so much they only eat in private out of embarrassment and spend much of their time thinking about food. “Most people [who] take drugs are not addicted to drugs, like most people who eat chocolate, even if they eat more than they should, are not addicted to chocolate.
“I may have that vulnerability, perhaps, for compulsiveness, but I am lucky enough to also have the control that leads me to plan ahead and say, I’m not going to do these things.” In other words, you can extend a hand from a present moment of strength to a future instance of weakness and wrestle your free will back from the dopamine master within.
Source: Rachael Moeller Gorman, an award-winning science writer, is a contributing editor for EatingWell.
About the Author:
An award-winning journalist, Rachael Moeller Gorman is a contributing editor at EatingWell and has written for such publications as Scientific American, Good Housekeeping, Discover, Proto, Cooking Light and The Boston Globe Health/Science section, among others. She loves learning about all things science, from the environment to anthropology to medicine, and enjoys translating dense jargon into elegant prose for a variety of audiences. Profiles are her favorite, and traveling to a research site for a story is always ideal.
Rachael has her bachelor’s degree in biology and neuroscience from Williams College and a master’s degree in environmental studies from Brown University. She has also conducted research in various genetics and neuroscience laboratories and is a member of the American Society of Journalists and Authors and the National Association of Science Writers. Please see the Articles section for a selection of her work.
Imported Foods Raise Obesity, Health Issues for Pacific Islanders
Source: Uploaded by VOALearningEnglish on Sep 22, 2010 to YouTube
This is the VOA Special English Development Report, from http://voaspecialenglish.com .
The World Health Organization says obesity rates are rising in Pacific island countries. So, too, are health problems linked to being overweight. The WHO says a major reason for the rising obesity rates is an increase in imported foods. It says many Pacific islanders have replaced their traditional diets of vegetables and fruits with imported processed foods.
Doctor Temu Waqanivalu is with the World Health Organization’s South Pacific office in Suva, Fiji. He says many of the imported products lack nutritional value. But they are widely available, he says, and often cost less than healthier foods.He says: “In some of the places, you’d be amazed to see how a bottle of Coke is cheaper than a bottle of water.”
Doctor Waqanivalu says the increase in imported foods is only part of the problem. He says problems with agriculture production limit the availability of healthier foods. And a lack of physical activity among many Pacific islanders only adds to the obesity problem.
The WHO says more than fifty percent of the population is overweight in at least ten Pacific island countries. The rate is as high as eighty percent among women in the territory of American Samoa. Fiji had the lowest obesity rate at thirty percent.In all, almost ten million people live in Pacific island countries. The WHO estimates that about forty percent of them have health disorders related to diet and nutrition. Diabetes rates are among the highest in the world. Forty-seven percent of the people in American Samoa have diabetes. So do forty-four percent of the people in Tokelau, a territory of New Zealand. By comparison, the diabetes rate is thirteen percent in the United States, a country that has its own problems with rising obesity.
Officials also note an increase in nutritional problems like anemia and not enough vitamin A in the diets of Pacific islanders. Doctor Waqanivalu says treating conditions related to obesity and diet puts pressure on limited health resources and budgets. Earlier this year, leaders of island nations met in Vanuatu for the first-ever Pacific Food Summit. Doctor Waqanivalu says the issues are finally getting the attention they deserve.
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